This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Wednesday, 18 January 2012

A New Start

Hello!

Well I have been in the States for months now and still haven't bought a PC. Blogging from a crappy tiny laptop notebook thing would probably cause me to loose my hair. So I am finally going to buy a real desktop computer.

Is anyone even still interested in this Blog? Should I let it die because I am no longer in the UK? Or do you want to hear some stories from the NHS frontlines that I never dared to post while I was actually physically present in England?

To be honest I was going to let it go. But then David Cameron's comments about Nurse's doing hourly rounds nearly caused me to choke to death on my own vomit.

He doesn't seem to grasp that one qualified nurse to 15+ patients is not going to be able to get around to everyone she is responsible for in a 12 hour shift. The only things she is going to be physically capable of handling are the most high priority doctors orders and tasks and emergencies. Those things are not going to go away at any point in her shift so that she can round.

What Cameron won't admit is that the government has had hiring freezes on qualified nurses for years, decades even, and that the trusts are refusing to pay for more than one or two qualified nurses to staff 40 bedded wards for a 12 hour shift. The acute medical wards have the sickest most complicated patients outside of critical care and also have the lowest staffing levels of qualified nurses in the hospital. In addition to that acute medical wards are also bombarded with elderly patients who need one to one care in order to survive and be treated with dignity. Bombarded is an understatement. The system simply cannot cope with the growing population of dependment, medically complicated elderly. It is the same here in the USA.

When qualified Nurses such as myself would call management crying and asking for help because patients were suffering we were told "tough" "not managements problem" "not within budget" "you aren't getting any help, deal with it" "grow up" "put on your big girl knickers" etc etc etc.

When we would tell management that forcing qualified nurses to fill in hundreds of forms in order to obtain emergency transfusions, medications, labwork, diagnostics, and equipment stopped us from getting near our patients, we were told "tough". If I had refused to fill in the forms in order to do a Cameron round on my patients I would have been held 100% responsible for any deaths that occured due to missed transfusions, medications, labwork, diagnostics and lack of equipment. David Cameron knows that this is the situation. He is not going to admit that government is NEVER going to finance the hospitals properly or force local managers to staff wards with enough qualified Nurses. So he is trying to pass on the blame for neglect of patients and save his own skin by depicting Nurses as people who just don't care. I would hope that the public isn't dumb enough to drink that Kool aid but comments I see in the papers make me despair.

In the early 90's hospitals had the bright idea of trying to control costs by reducing the number of qualified Nurses at the bedside. The managers who control staffing and budgets are people with backgrounds in finance. They are not people with a background in health care. They do not understand how crucial qualified Nurses at the bedside are to patient outcomes. These people also do not hold a license to practice in the way that a doctor or a qualified nurse does. Therefore they cannot get held responsible for the lapses in care that are caused by their refusal to staff hospitals with enough qualified people. They make a lot of money from forcing doctors and nurses to take on uncontrollable workloads and by replacing qualified staff with unqualified people. And they are not the ones who get labelled as uncaring and incompetent by the papers, even though they have total and sole control. They even make it so bad that as a qualified nurse I cannot even control how long I spend with each patient, except to keep the time to less than a minute. Junior doctors have it a lot worse when they are carrying the bleep for medicine.

We do care. But patients sure aren't going to see that side of us when we are prioritizing, overwhelmed, full of anxiety, hungry, exhausted, panicked and scared shitless. And angry. We ARE ANGRY. We are not angels, or superhumans or demons or anything else. We are just plain people trying to do our best. Granted that health care professionals can handle a lot more than most people. But we are by no means magical, perfect or superman.

When these finance cunts are told that patients are suffering and dying their response to the health care professionals is often "tough" "deal with it" and "sucks to be you, nursey".

Now who is uncaring? The Nurses and the Doctors? Don't think so.

Caring with no control over the situation equals no care at all. Your doctors and nurses care. But they are simply cut off from time, resources, control and support from budget driven cunts with MBAs.

By the way, if you walk onto a ward and see support workers and secretaries sitting at the Nurse's station gossiping and cackling .......it is no indication of how busy the Nurses and Doctors are at that moment. Unqualified staff cannot help us with most tasks. Just an FYI.

So yeah I was pretty sick over David Cameron's comments, enough to want to start blogging again.

My readers have probably all grown old and died by now ;). But if anyone out there has looked at this, thanks for reading!

I'm so glad to see you're back, hope it's all going well for you in USA. I'm a nurse educator & before that was a community nurse, so many people leave the wards because it us intolerable & added to that is guilt for leaving people to their fate. Cameron disgusts me, my students are caring and idealistic but it beaks my heart to think how they will be ground down by the system. Good t hear you speaking out again .

I give your students 6 months on the job (if they get a job) before the suicidal ideations start.

My colleagues (the very few of us who were qualified nurses) used to play this game where we all drove to work without seatbelts on hoping that a car accident would kill or maim us enough to provide an escape from the hell. When we would all make it into work alive we would say "dammit, none of us lucked out today"

Please write all those NHS stories you couldn't before.Thinking about going into nursing in order to emigrate!Did you note the announcement yesterday on London training for nurses - focussing on empathy and compassion in recruiting trainees by cutting the numbers.Poppy.

You want to see the state of the mental health wards. Without even starting on the chronic lack of any dual trained nurses (which makes the junior doctors have to act as 'physical health' gimps because they are literally the only people on the ward with any knowledge of physical illness) the mental health nurses are in such short supply (being replaced by HCAs and 'mental health practitioners' whatever they are) that they have to spend all their time doling out the meds.

PJ, I can believe it about mental health nurses. The government gets away with it because the public is so ignorant about what a nurse is. Joe public things that if the ward employs a nice young lady with empathy who brings him cups of tea it means that he has "good nursing care". What does Joe understand about meds, doctors orders and nurse assessments for changes in condition? Nothing. Anyway I am sorry to hear that things are so shit in the mental health sector.

I too am pleased that you may return to reflecting on you NHS experiences and look forward to you sharing thoughts that - even you - found difficult to share while still working in the UK. Welcome Back

Nah, it's a total clusterfuck. The ER sent me a patient who stopped breathing the second he hit my floor yesterday and someone else went to IR with a high INR because some lab results got switched.

Better staffing ratios but much sicker patients. And they don't let anyone die here. We have 103 year olds with dementia on the wards with cardizem drips and telemetry, central lines, and everything else. When the government pays (as they do with old people) the hospital milks the system for all they can get.

So glad you are back, just clicked on my old "favourite" on the off chance and here you are. Looking forward to more tales of UK and US. Others on here in the UK might be interested to see More4 tonight a documentary promising to show what nurses really think . . . could be interesting.Nurse Armadillo

Poster above- I watched that documentary and I'm not sure what to think yet. I need to watch the next couple in the series I think before I make up my mind if it's true to life or not. You can bet the hospitals chose the "best" wards for them to film in.

I hope things are working out for you over there, and I hope you get time to write more - everytime a relative or friend would bitch about the NHS this is where i would send them, so the more the better. Must be good to be loved! (In fact Jobbing Doctor lamented the cessation of your blog just the other day...)

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In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.